title: Neuromuscular block reversal with sugammadex in a morbidly obese patient with myasthenia gravis.
abstract: BACKGROUND
  Myasthenia gravis is a rare immunological illness that impairs neuromuscular transmission. Myasthenic patients are usually hypersensitive to non-depolarising muscle relaxants, and reversal with neostigmine is rarely effective. We report the successful reversal of rocuroniuminduced neuromuscular block in a morbidly obese myasthenic patient.
  
  
  METHODS
  A 38-year-old morbidly obese (body weight 160 kg, BMI 48.8 kg m⁻²) woman was scheduled for elective laparoscopic gastric banding. She was anaesthetised with propofol-based TIVA; intubation was facilitated by 24 mg of rocuronium. After spontaneous recovery of T1, she received 200 mg of sugammadex, which completely restored the NMT ratio (TOF=100%) within 2 min and 48 sec., and she was extubated. No postoperative complications were observed.
  
  
  CONCLUSIONS
  Sugammadex can be successfully used in myasthenic patients, allowing for the safe use of muscle relaxants in these patients.
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, Medical University in Łódz. jakubiakj@yahoo.com
authors.forename: Jakub
authors.initials: J
authors.lastname: Jakubiak
authors.forename: Tomasz
authors.initials: T
authors.lastname: Gaszyński
authors.forename: Wojciech
authors.initials: W
authors.lastname: Gaszyński
mesh_terms: D000328:Adult; D000732:Androstanols / Q000008:administration & dosage / Q000037:antagonists & inhibitors*; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D015391:Gastroplasty / Q000379:methods; D006801:Humans; D009157:Myasthenia Gravis / Q000503:physiopathology*; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000037:antagonists & inhibitors; D009767:Obesity, Morbid / Q000601:surgery*; D015742:Propofol / Q000008:administration & dosage; D000077123:Rocuronium; D000077122:Sugammadex; D013997:Time Factors; D047408:gamma-Cyclodextrins / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077123:Rocuronium; D015742:Propofol